Anesthesia Industry eAlerts
Sent to subscribers every Monday morning, our eAlerts deliver timely updates on regulatory, legislative and practice management developments of interest to anesthesia professionals.
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eAlerts
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Last Call for Anesthesiologists to Report PQRI Measures in 2010
June 28, 2010
If you have not begun reporting Physician Quality Reporting Initiative (PQRI) measures on your claims to Medicare, you will have a second and final opportunity starting this Thursday, July 1. You can qualify for the 2% bonus incentive payment on your Medicare allowables for the six-month period July-December by reporting quality measures on at least 80% of your eligible claims.
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Proposed Rule for 2011 Physician Fee Schedule
July 6, 2010
CMS has released the 1250-page proposed rule containing changes to the Medicare Physician Fee Schedule for 2011. Chief among these changes is the calculation of next year’s conversion factor. By now you have probably heard that the proposed rule would cut payments by another 6.1 percent, effective January 1, 2011. We want to be sure you know that this is not a real number. It is driven by the Sustainable Growth Rate (SGR) formula and certain proposed shifts in relative values between various specialties.
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PQRI 0.5% Bonus For Maintenance of Certification in Anesthesiology
July 12, 2010
The national average anesthesia conversion factor (CF) for June 1st through November 30th is $21.5696. The highest local area CFs are to be found in Alaska ($30.15), Miami ($24.96), Detroit $(23.65) and Chicago ($23.60) and the New York City suburbs ($23.49).
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Anesthesiologist-Hospital Arrangements and the OIG’s Increasing Scrutiny
July 19, 2010
While hospitals’ efforts to align themselves more closely with physician practices have been increasing, so has the attention of the Office of the Inspector General (OIG) of the Department of Health and Human Services. Relationships between physicians and facilities offer numerous, more or less creative and often unintended ways of violating the ban on self-referral and the ban on kickbacks. A review of a seminal OIG Advisory Opinion on a cost-saving arrangement between a hospital and its anesthesiology group will help readers navigate the territory.
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Hospital Contracts with Anesthesia Management/Staffing Companies
August 2, 2010
One strategy many anesthesia practices consider, in dealing with an economy that is still in the doldrums, is growth through merger with other groups. Another option is to sign up with a large anesthesia management/staffing company (“management company”) and leave the business hassles to that company. The latter scenario is more likely to be involuntary and the anesthesia practice is less likely to have a strong bargaining position. It is of vital importance in both cases to familiarize oneself with the contract being offered. In this Alert, we focus on the situation where the management company appears, unbidden, on one’s doorstep.
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Creative Documentation by Anesthesiologists May Lead to Medical Board Disciplinary Action
July 26, 2010
It’s hard to read much on the subject of anesthesia practice management without coming across the phrase “fraud and abuse.” Practitioners of this specialty have been thoroughly indoctrinated in the perils of inadequately or improperly documenting their services.
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Anesthesiologists to Medicare and Private Payers: Show Me the Money
June 21, 2010
No, you haven’t already read this Alert stating that the 21.3 percent Medicare physician payment cut is now in effect. Yet again Congress has failed to pass legislation preventing us from going over the cliff. Late on Friday the Senate finally passed its version of the House-approved postponement of the SGR reduction in payments to physicians – too late to stop Medicare from beginning to process claims at the lower rate.
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MEDICARE CONTINUES TO HOLD YOUR JUNE CLAIMS – CONGRESS EXPECTED TO TAKE ACTION
June 15, 2010
CMS has announced that it will extend the current hold on claims for services performed on or after June 1st through June 17th so that Congress can complete action on the SGR fix. This follows on President Obama’s plea that the Senate pass legislation that would block the 21.3% cut in Medicare payments to physicians during his weekly presidential address last Saturday.
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Anesthesia Employment Contracts and Fee-Splitting
June 14, 2010
“Dr. P.,” an anesthesiologist, was hired as the medical director of a for-profit ambulatory surgery center, “ASC-D.” Dr. P. and the other members of the anesthesiology department were to provide anesthesia services at ASC-D and at a number of off-site private physicians' offices. Dr. P.’s employment contract required him to turn over all fees earned from anesthesia services, including cases performed off the ASC’s premises. Under the contract, Dr. P., like other anesthesiologists employed by the ASC, was to receive a share of those fees back in the form of distributions from the annual “Net Anesthesia Revenue Pool” in addition to his base salary.
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Another Reason for Anesthesiologists to Resist Medicare Linkages in Their Private Payer Contracts
June 7, 2010
You already know that basing private health plan payment rates on the Medicare Fee Schedule would bankrupt your practice. We do not know of any anesthesia practice that has ever been forced to accept 100% of the Medicare conversion factor, but there are some groups that have agreed to 150% or other multiples of Medicare.
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Four Important Medicare Updates for Anesthesiologists
June 1, 2010
Today, June 1st, is the date that the 21.2 percent un- Sustainable Growth Rate (SGR) reduction in Medicare payments to physicians is going to go into effect. Once again Congress is trying to pass legislation that will give physicians a very small increase for now and defer solving the SGR problem until a later date – 2014, under the American Jobs and Closing Tax Loopholes Act of 2010 (H.R. 4213). The Senate adjourned without taking up the bill, however; it will return on June 7th.
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$10 Million Cost of Terminating an Anesthesiologist - Lessons Learned
May 24, 2010
Pinnacle Anesthesia Consultants of Dallas, TX terminated shareholder Neal Fisher, MD in a manner that cost the group more than $10 million by the time the state court appeal was over.
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Compliance – The Issue That Just Won’t Go Away for Anesthesia Practices
May 17, 2010
Anesthesia groups should review their compliance programs in light of the emphasis on combating fraud and abuse in the Patient Protection and Affordable Care Act (PPACA). While physicians account for a very small part of the billions of dollars paid out erroneously each year, the risks of flunking an audit and being faced with overpayment or fraud liability outweigh the hassle of compliance for most practices.
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SPECIAL ALERT Tell Washington to Use the Health Care Reform Law to Review the Anesthesia Conversion Factor
May 12, 2010
Four key members of the U.S. House of Representatives are seeking support from their colleagues for a letter to the Department of Health and Human Services requesting a review of the accuracy of Medicare's payments for anesthesia services.
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New Requirements for Documenting Pre-, Intra- and Post-Anesthesia Evaluations
May 10, 2010
Many anesthesiologists are uncertain how the Revised Anesthesia Services Interpretive Guidelines issued by the Centers for Medicare and Medicaid Services (CMS) in December 2009 changed documentation requirements.
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THE OTHER BIG MEDICARE PAYMENT PROBLEM – THE LOW, LOW ANESTHESIA CONVERSION FACTOR
May 3, 2010
Medicare pays about 33 percent of average commercial payments for anesthesia services. This fact, well known to anesthesiologists, was one of the findings in a report published by the Government Accountability Office in 2007. The GAO study was based on a representative sample of anesthesia services performed in 41 Medicare payment localities. Other specialties, including pain medicine, collect an average of 80 percent or more of their commercial rates for Medicare patients.
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Electronic Health Records – HITECH Act Incentives For Pain Physicians
April 26, 2010
The Health Information Technology for Economic and Clinical Health Act (HITECH) provisions of the 2009 Recovery Act establish financial incentives starting in 2011 for “eligible professionals” (EPs) who are meaningful users of certified electronic health record (EHR) technology. EPs who qualify may receive up to $44,000 over 5 years, beginning in 2011.
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When Should Anesthesiologists Bill the Consultation Codes?
April 19, 2010
As of January 1, 2010, Medicare stopped accepting claims for consultation services (CPT® codes 99241– 99245 and 99251–99255). Instead, physicians are to report the appropriate evaluation and management (E&M) codes:
- 99201-99205 (New Office/Outpatient Visit)
- 99211-99215 (Established Office/Outpatient Visit)
- 99221-99223 (Initial Hospital Care)(inpatient)
- 99231-99233 (Subsequent Hospital Care)
CMS claimed that the change was budget neutral in that the total relative value units assigned to the consultation codes were redistributed among the E&M codes. Many anesthesiologists and other physicians are finding, however, that the lower payments for the E&M codes are putting a dent in their revenues.
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RAC Rules : HITECH Act Electronic Health Record Incentive Program- Bonus or Penalty for Anesthesiologists?
April 12, 2010
Most physicians have heard that they are going to be eligible for a federal payment of up to $44,000 between 2011 and 2015 if they use an electronic health record (EHR). Anesthesiologists continue to wonder, however, whether they will qualify for the bonus, since they rarely invest directly in EHRs or electronic anesthesia records, relying more typically on the hospital’s information technology (IT).
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RAC Rules: Pre- and Post-Op Visits No Longer Bundled With Anesthesia Service
April 5, 2010
Before a Medicare Recovery Audit Contractor (RAC) may send a demand letter or a request for records to a provider, an improper payment “issue” must first be approved and be posted on the RAC’s website. In January of this year, one of the first CMS-approved issues relating to anesthesia appeared on Health Data Insight’s website. HDI is the RAC for Region D, which encompasses Alaska, Arizona, California, Hawaii, Iowa, Idaho, Kansas, Missouri, Montana, North Dakota, Nebraska, Nevada, Oregon, South Dakota, Utah, Washington, Wyoming and three U.S. territories.
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What Does the Health Care Reform Legislation Mean for Anesthesia Practices?
March 29, 2010
On Friday afternoon, March 26th, the Senate adjourned for the “Spring District Work Recess” without adopting legislation that would have extended current Medicare physician payment rates through April 30, 2009. A vote on extending those rates is scheduled for the afternoon of April 12th, the day that the Senate returns. Readers should make sure to contact their Senators once again to communicate the urgency of repealing the sustainable growth rate (SGR) formula – not just for deferring the SGR-driven decrease.
